After care visit for contact lenses

1. Contact Lens:
After care Visit
Rabindra Adhikary
ravinems@iom.edu.np

2. acknowledgement
• Mr.Prakash Paudel
2

3. references
• 1.Anthony J.Philips, Janet Stone
▫ Contact Lenses, 3rd
edition
• 2. Contact Lenses :Procedures & Techniques
▫ Gerald E. Lowther
• 3.Lecture notes
• 4.Internet
3

4. purpose
• to develop & sustain good lens
performance
• to find out ocular pathology induced by
CL
• to find out post wear ocular changes by
CL
• to find out factors responsible for
discomfort
4

5. contents
• case history
• aftercare examination
• review of care & maintenance
• resolution of problems
• discussion of findings
• Success criteria
• Advise & treatment
5

6. approach
• vary for different purpose;
▫ soft contact lens
▫ RGP
▫ toric
▫ therapeutic contact lens
▫ prosthetic contact lens
▫ aphakic contact lens
▫ Cosmetic contact lens
6

7. based on
• history of CL use, time & limitation
• symptoms analysis in regard to
prevalence , duration & associated
circumstances
• evaluation of vision performance
• examination of lens fitting
• examination under slit lamp
biomicroscopy
• reassessment of lens parameters
• non-routine tests & measurements:
tear film analysis, keratometry ,
corneal sensitivity
7

8. History taking…
8

9. History taking
• wearing modality ; hrs/day,
days/wk
• brand of soln. used
• visit ; time,date,visit number
• quality of vision ,comfort,
ease of handling
• active listening is key element
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10. History taking...
• blur
• redness
• discharge
• excessive tearing
• photophobia & pain
• spectacle blur
• glare
• diplopia
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11. Ocular examination
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• with contact lens:
▫ visual acuity ; near + distance
▫ comfort
▫ quality of vision
▫ CL fitting evaluation ;
 SCL ; centration, coverage, movement
 RGP; static –bearing , pooling
: dynamic ;centration, stability, movement
▫ blinking frequency
▫ head posture
▫ Keratometry (FSK)
▫ retinoscopy & refraction
▫ binocular vision testing

12. 12

13. Ocular examination...
•with contact
lens off:
▫ Visual acuity
▫ Biomicroscop
y ; conjunctival
congestion,
papillae, corneal
staining
▫ tear evaluation
13

14. 14
Ocular examination...
▫ keratometry :change
in corneal
curvature:>0.50D is
significant edema
▫ retinoscopy &
refraction
▫ other tests :
pachymetry, corneal
sensitivity

15. 15
Ocular examination…
• Evaluation of Contact Lens:
▫ deposits, surface & edge inspection; scratches
▫ parameter measurement /verification
 -radiuscope
 -focimeter
 V-gauge

16. review of care & maintenance
• lens handling
• solution use
• hygiene
• Additional instruction ; traveling ,
sports, taking medication
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17. 17

18. 18

19. 19

20. Symptom analysis
• blur-incorrect lens power , corneal
oedema,dehydration,poor fitting
• Tight lens fitting –vision clear
immediately after blink & vice versa for
flat lens
• discomfort-damaged lens, poor edge,
decentred lens, FB under lens, soln.
toxicity
• photophobia & pain-corneal edema,
SPKs
• Burning –soln. toxicity, dry eye
20

21. Symptom analysis...
• Redness –lens
irritation,while insertion
& removal
• Discharge-infections
• flare/ghost images-
decentred optic zone
area, inadequate pupil
coverage
• distortion-faulty optical
quality & residual
astigmatism
• Cosmetics associated 21

22. problem encountered• bubbles –decrease vision ,increase
flare
• Reading difficulty – myopes have
to accommodate more
• Ghost images- due to poor lens
wetting & lens displacement ,
incomplete pupil coverage
• Chronic hyperemia-expose to
smoke ,wind,dust or glare
22

23. problem encountered…
• Discoloration-
absorption of amino acid
, changed tear chemistry
• Tear deficiency –
meibomian gland
secretion obstruction ,
insufficient blinking
• corneal infiltrates-occur
in response to soln.
preservative
• corneal edema-becoz of
hypoxia; striae,fold
23

24. problem encountered…
• GPC-due to
material/soln allergy.
-Mucus discharge,
itching , giant papillae
• Over wear syndrome –
significant edema with
PMMA ; 3
a.m.syndrome-
awakens at night,
severe pain
• SEAL(superior
epithelial actuate
lesion)- due to thick
SCL
• Smile ( Inferior
arcuate lesion) 24

25. problem encountered…
• SLK(superior limbic
keratitis)-mechanical
irritation by edge,
hypoxia, soln.
Preservatives
• 3 & 9 O,clock staining-
hard lenses
• Corneal warpage
• CLARE
• CLPU
• MK
25

26. problem encountered…
• Vascularisation-over wear , loss of
epithelial integrity,tight lens, poorly
finished edges
26

27. problem encountered…
• Glaucoma-corneal edema
• Diabetes-intolerance to contact lens
wear, reduced sensitivity, recurrent
epithelial erosions
• Hormonal factors ; edema results
during menstrual cycle , during
pregnancy
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28. Success criteria
• Wearing time
▫ DW: 12hr/day for 5 days or more/wk
▫ EW: 6 or more consecutive nights before an
overnight removal
• Comfort
▫ SCL-immediately after insertion and remain
for wearing period
▫ RGP-should be comfort by 1 month
• Vision
:= / > than spectacle acuity
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29. 29

30. 30

31. advice/ treatment
• reassurance of the caring system
• demonstration of the handling procedures
• complication
-discontinuation of CL
-decreasing wearing duration
▫ change in lens material; water content/
thickness/ design
▫ specific treatment for specific problem
31